Text Size

-

+

reset

The exchanges are supposed to have a super-speedy way to check all of the things they’re supposed to check, and that’s why the Obama administration is building a system that’s supposed to give them real-time access to data from all of the agencies that have to verify whether you’re eligible for Obamacare.

It’s supposed to let the exchanges talk to the Social Security Administration (to check your Social Security number), the IRS (to check your income against your latest tax return) and the Department of Homeland Security (to make sure you’re a citizen). It’s also supposed to check with state Medicaid and Children’s Health Insurance Program agencies to make sure you’re not already enrolled there.

But that’s a big technological feat to pull off by October, and the actual status of the “hub” has been a bit of a mystery. Pearce, the Maryland health exchange director, says the exchange has already done a trial run with it and was able to get answers within “milliseconds.”

But a recent report by the Government Accountability Office said that while the hub has been through some testing, some critical tasks — like finishing all testing with federal agencies and states, and working out the service agreements — haven’t been done yet. And House Republicans have raised questions about whether the hub will be “operable and able to protect sensitive health and taxpayer information.”

“The question is really: Is the federal version of the hub going to be there?” said Solomon of the Center on Budget and Policy Priorities.

Not getting enough subsidies could cause other problems

The real problem could come when people try to estimate their incomes and they don’t get it right — or it changes in the middle of the year.

If their incomes drop, for example, Congress won’t be as worried about that because it means they didn’t get as much of an Obamacare subsidy as they could have received.

But if people who apply for Obamacare are encouraged to low-ball their incomes to avoid penalties and they find that their subsidy won’t be very big, it could scare some people away — especially the young and healthy people the exchanges will need to help pay for the sick people, said Laszewski.

“The sick people are going to fight to get it right. The healthy people are going to say, ‘Ah, forget it,’” said Laszewski.

But there are also cases in which someone’s income goes up in the middle of the year — like if they get married or they just get a better-paying job — and suddenly they don’t qualify for as much in subsidies. The Obamacare applications are going to encourage people to report any mid-year changes, but people who don’t could face the consequences at tax time.

“It’s just an odd thing for some people to have to know what their income is going to be,” said an administration official. “You don’t want to punish people who are just trying to get health insurance.”

The individual mandate has an honor system, too

Trying to get out of the individual mandate? The Obamacare law has a list of ways you can do that — and with a few of them, all you’ll have to do is list the reason on your tax return.

Under the law, the vast majority of people won’t have to worry about the mandate anyway — they’ll have health coverage that already satisfies it, like health insurance through the workplace, Medicare or Medicaid.

But if you’re one of the uninsured people who falls under the individual mandate, you can get out of it if you had a hardship (like a sudden and expensive event), you’d have to pay too much of your income for the only health coverage you can find, your income is too low to owe any taxes, you’re a member of a religious group that opposes all insurance benefits, you’re a member of a native American tribe or you’re in jail. And people who are in the country illegally aren’t subject to the mandate.

For some of those exemptions — most of the hardship cases and the religious reasons — you’ll have to get a “certificate of exemption” from the health insurance exchange. The federal rules say they have to check what you say by seeing, for example, whether your religious group is recognized as a religious sect by the Social Security Administration or asking for proof of your hardship.

But for the others — you can’t find affordable coverage or you had short gaps in health coverage lasting less than three months — you’ll just put that down on your tax return. And if your income is too low to owe taxes, of course, you just won’t file a return.

How will the IRS check the exemptions you claim on your tax return? It’ll only happen if you’re audited.

For people who don’t owe any taxes, however, Obama administration officials say it’s likely that they’d just get Medicaid coverage anyway.